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When I was younger and made next to nothing, I ended up in the emergency room with a bill I couldn't possibly afford to pay. I called up the billing dept and told them about my financial situation and they told me to contact Health Quest so I qualify for a discount. It was relatively easy and not only did it erase my previous debt but it gave me a 0% liability for any hospital fees for the next 6mos. The funny thing was that the hospital ended up selling my my debt to collections by that point so every time they called id fax them a copy of a letter and id never hear from them again and after a few times of them selling this debt to other collectors it just got dropped. This was in upstate NY in like 2010 so YMMV.
It can vary heavily like you're saying. By law, all hospitals must treat all patients who arrive at the ER.
Most hospitals have programs so they can provide care for those who can't afford it, though. Usually around 20-25% of their revenue is used to cover those patients.
If you qualify for Medicaid, they can backdate your enrollment so you'd be covered even before you arrived at the hospital. Coverage can vary, but this usually should cover all medical bills at no cost.
The big issue usually isn't people who have no insurance or are too poor. It's from hospitals treating you while your insurance refuses to pay. Normally this is because the bill was miscoded, but it can also be due to an uncovered treatment, high deductibles and OOP limits, or the insurance just being greedy.
Sometimes the hospital or doctors can work things out to minimize your bills, other times they can't.
A lot of the protections above came about because of the Affordable Care Act (Obamacare). Before then, there were common horror stories of people who had hundreds of thousands in medical debt because they reached their lifetime maximum coverage - something that's illegal now. Insurance could (and often would) just tell people they're on their own from now on because it's too expensive to keep them alive. Your coverage could be changed whenever the insurance company felt like it. And up until last year, they could make you pay for treatment if an out-of-network doctor decided to pop on by while you're at an in-network facility.
That sounds a lot like the death panels we were warned about except this time, the death panels make more money with each denial.
It was, but conservatives don't mind because they were run by the benevolent health insurance companies who never would screw us over 🫠